diversified health occupations · 2016. 10. 12. · matthew kane managing editor: marah bellegarde...

DIVERSIFIEDHEALTHOCCUPATIONSSeventh Edition

Louise Simmers, MEd, RNKaren Simmers-Nartker, BSN, RNSharon Simmers-Kobelak, BBA

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Diversifi ed Health Occupations, Seventh

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Louise SimmersKaren Simmers-NartkerSharon Simmers-Kobelak

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CHAPTER 9 Cultural Diversity

Observe Standard Precautions

Instructor’s Check—Call Instructor at This Point

Safety—Proceed with Caution

OBRA Requirement—Based on Federal Law

Math Skill

Legal Responsibility

Science Skill

Career Information

Communications Skill

Technology

Chapter ObjectivesAfter completing this chapter, you should be able to:

◆ List the four basic characteristics of culture

� Differentiate between culture, ethnicity, and race

� Identify some of the major ethnic groups in the United States

� Provide an example of acculturation in the United States

� Create an example of how a bias, prejudice, or stereotype can cause a barrier to effective relationships with others

� Describe at least fi ve ways to avoid bias, prejudice, and stereotyping

� Differentiate between a nuclear family and an extended family

� Identify ways in which language, personal space, touching, eye contact, and gestures are affected by cultural diversity

� Compare and contrast the diverse health beliefs of different ethnic/cultural groups

� List fi ve ways health care providers can show respect for an individual’s religious beliefs

� Identify methods that can be used to show respect for cultural diversity

� Defi ne, pronounce, and spell all key terms

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CHAPTER 9258

9:1 INFORMATIONCulture, Ethnicity, and RaceHealth care providers must work with and pro-vide care to many different people. At the same time, they must respect the individuality of each person. Therefore, every health care provider must be aware of the factors that cause each indi-vidual to be unique. Uniqueness is infl uenced by many things including physical characteristics (sex, body size, and hair, nail, and skin color), family life, socioeconomic status, religious beliefs, geographical location, education, occupation, and life experiences. A major infl uence on any individual’s uniqueness is the person’s cultural/ethnic heritage.

Culture is defi ned as the values, beliefs, atti-tudes, languages, symbols, rituals, behaviors, and customs unique to a particular group of people and passed from one generation to the next. It is often defi ned as a set of rules, because culture provides an individual with a blueprint or general design for living. Family relations, child rearing, education, occupational choice, social interac-tions, spirituality, religious beliefs, food prefer-ences, health beliefs, and health care are all infl uenced by culture. Culture is not uniform among all members within a cultural group, but it does provide a foundation for behavior. Even though differences exist between cultural groups and in individuals within a cultural group, all cul-tures have four basic characteristics:

♦ Culture is learned: Culture does not just hap-pen. It is taught to others. For example, chil-dren learn patterns of behavior by imitating

adults and developing attitudes accepted by others.

♦ Culture is shared: Common practices and beliefs are shared with others in a cultural group.

♦ Culture is social in nature: Individuals in the cultural group understand appropriate behav-ior based on traditions that have been passed from generation to generation.

♦ Culture is dynamic and constantly changing:New ideas may generate different standards for behavior. This allows a cultural group to meet the needs of the group by adapting to environmental changes.

Ethnicity is a classifi cation of people based on national origin and/or culture. Members of an ethnic group may share a common heritage, geo-graphic location, social customs, language, and beliefs. Even though every individual in an ethnic group may not practice all of the beliefs of the group, the individual is still infl uenced by other members of the group. There are many different ethnic groups in the United States (fi gure 9-1). Some of the common ethnic groups and their countries of origin include:

♦ African American: Central and South African countries, Dominican Republic, Haiti, and Jamaica

♦ Asian/Pacifi c American: Cambodia, China, Guam, Hawaii, India, Indonesia and Pacifi c Island countries, Japan, Korea, Laos, Philip-pines, Samoa, and Vietnam

♦ European American: England, France, Ger-many, the Netherlands, Ireland, Italy, Norway,

KEY TERMS

acculturationagnosticatheistbiascultural assimilationcultural diversitycultureethnicity

ethnocentricextended familyholistic carematriarchal (may�-tree-ar�-

kel)nuclear familypatriarchal (pay�-tree-ar�-kel)

personal spaceprejudiceracereligionsensitivityspiritualitystereotyping



259Cultural Diversity

Poland, Russia, Scandinavia, Scotland, and Switzerland

♦ Hispanic American: Cuba, Mexico, Puerto Rico, Spain, and Spanish-speaking countries in Central and South America

♦ Middle Eastern/Arabic Americans: Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Palestine, Saudi Arabia, Yemen, and other North African and Middle Eastern countries

♦ Native American: more than 500 tribes of American Indians and Eskimos

It is important to recognize that within each of the ethnic groups, there are numerous sub-groups, each with its own lifestyle and beliefs. For example, the European American group includes Italians and Germans, two groups with different languages and lifestyles.

Race is a classifi cation of people based on physical or biological characteristics such as the color of skin, hair, and eyes; facial features; blood type; and bone structure. Race is frequently used to label a group of people and explain patterns of behavior. In reality, race cuts across multiple eth-nic/cultural groups, and it is the values, beliefs,

and behaviors learned from the ethnic/cultural group that generally account for the behaviors attributed to race. For example, blacks from Africa and blacks from the Caribbean both share many of the same physical characteristics, but they have different cultural beliefs and values. In addi-tion, there are different races present in most eth-nic groups. For example, there are white and black Hispanics, white Africans and Caribbeans, and white and black Asians.

Culture, ethnicity, and race do infl uence an individual’s behavior, self-perception, judgment of others, and interpersonal relationships. These differences based on cultural, ethnic, and racial factors are called cultural diversity. It is impor-tant to remember that differences exist within ethnic/cultural groups and in individuals within a group. In previous times, the United States has often been called a “melting pot” to represent the absorption of many cultures into the dominant culture through a process called cultural assim-ilation. Cultural assimilation requires that the newly arrived cultural group alter unique beliefs and behaviors and adopt the ways of the domi-nant culture. In reality, the United States is striv-ing to be more like a “salad bowl” where cultural

FIGURE 9-1 The many faces of the United States.



CHAPTER 9260

differences are appreciated and respected. The simultaneous existence of various ethnic/cul-tural groups gives rise to a “multicultural” society that must recognize and respect many different beliefs. Acculturation, or the process of learn-ing the beliefs and behaviors of a dominant cul-ture and assuming some of the characteristics, does occur. However, acculturation occurs slowly over a long period, usually many years. Recent immigrants to the United States are more likely to use the language and follow the patterns of behavior of the country from which they emi-grated. Second- and third-generation Americans are more likely to use English as their main lan-guage and follow the patterns of behavior preva-lent in the United States (fi gure 9-2).

Because they provide care to culturally diverse patients in a variety of settings, health care pro-viders must be aware of these factors and remem-ber that no individual is 100 percent anything! Every individual has and will continue to create new and changing blends of values and beliefs. Sensitivity, the ability to recognize and appreci-ate the personal characteristics of others, is essential in health care. For example, in some cultures such as Native Americans or Asians, call-ing an adult by a fi rst name is not acceptable except for close friends or relatives. Sensitive health care workers will address patients by their last names unless they are asked to use a patient’s fi rst name.

9:2 INFORMATIONBias, Prejudice, and StereotypingBias, prejudice, and stereotyping can interfere with acceptance of cultural diversity. A bias is a preference that inhibits impartial judgment. For example, individuals who believe in the suprem-acy of their own ethnic group are called ethno-centric. These individuals believe that their cultural values are better than the cultural values of others, and may antagonize and alienate peo-ple from other cultures. Individuals may also be biased with regard to other factors. Examples of common biases include:

♦ Age: Young people are physically and mentally superior to older people.

♦ Education: College-educated individuals are superior to uneducated individuals.

♦ Economic: Rich people are superior to poor people.

♦ Physical size: Obese and short people are infe-rior.

♦ Occupation: Nurses are inferior to doctors.

♦ Sexual preference: Homosexuals are inferior to heterosexuals.

♦ Gender: Women are inferior to men.

Prejudice means to prejudge. A prejudice is a strong feeling or belief about a person or sub-ject that is formed without reviewing facts or information. Prejudiced individuals regard their ideas or behavior as right and other ideas or behavior as wrong. They are frequently afraid of things that are different. Prejudice causes fear and distrust and interferes with interpersonal relationships. Every individual is prejudiced to some degree. We all want to feel that our beliefs are correct. In health care, however, it is impor-tant to be aware of our prejudices and to make every effort to obtain as much information about a situation as possible. This allows us to learn about other individuals, understand their beliefs, and communicate successfully.

Stereotyping occurs when an assumption is made that everyone in a particular group is the same. A stereotype ignores individual character-istics and “labels” an individual. A classic exam-ple is, “All blondes are dumb.” This stereotype has been perpetuated by “blonde jokes” detrimental

FIGURE 9-2 Second- or third-generation individu-als in the same ethnic/cultural group will adopt many patterns of behavior dominant in the United States.




to individuals who have light colored hair. Similar stereotypes exist with regard to race, sex, body size (thin, obese, short, or tall), occupation, and ethnic/cultural group. It is essential to remember that everyone is a unique individual. Each person will have different life experiences and exposure to other cultures and ideas. This allows a person to develop a unique personality and lifestyle.

Bias, prejudice, and stereotyping are barriers to effective relationships with others. Health care providers must be alert to these barriers and make every effort to avoid them. Some ways to avoid bias, prejudice, and stereotyping include:

♦ Know and be consciously aware of your own personal and professional values and beliefs.

♦ Obtain as much information as possible about different ethnic/cultural groups.

♦ Be sensitive to behaviors and practices differ-ent from your own.

♦ Remember that you are not being pressured to adopt other beliefs, but that you must respect them.

♦ Develop friendships with a wide variety of people from different ethnic/cultural groups.

♦ Ask questions and encourage questions from others to share ideas and beliefs.

♦ Evaluate all information before you form an opinion.

♦ Be open to differences.

♦ Avoid jokes that may offend.

♦ Remember that mistakes happen. Apologize if you hurt another person, and forgive if another person hurts you.

9:3 INFORMATIONUnderstanding Cultural DiversityThe cultural and ethnic beliefs of an individual will affect the behavior of the individual. Health care providers must be aware of these beliefs in order to provide holistic care; that is, care that provides for the well-being of the whole person and meets not only physical needs, but also social, emotional, and mental needs. Some areas of cultural diversity include family organization, language, personal space, touching, eye contact, gestures, health care beliefs, spirituality, and religion.

FAMILY ORGANIZATIONFamily organization refers to the structure of a family and the dominant or decision-making person in a family. Families vary in their compo-sition and in the roles assumed by family mem-bers. A nuclear family usually consists of a mother, father, and children (fi gure 9-3). It may also consist of a single parent and child(ren). An extended family includes the nuclear family plus grandparents, aunts, uncles, and cousins (fi gure 9-4). The nuclear family is usually the basic unit in European American families, but the extended family is important. The basic unit for Asian, Hispanic, and Native Americans is gen-erally the extended family, and frequently, several different generations live in the same household. This affects care of children, the sick, and the elderly. In extended family cultures, families tend

FIGURE 9-3 A nuclear family usually consists of a mother, father, and children.

FIGURE 9-4 An extended family includes grand-parents, aunts, uncles, and cousins in addition to the nuclear family.



CHAPTER 9262

to take care of their children and sick or elderly relatives in their home. For example, most Asian families have great respect for their elders and consider it a privilege to care for them. In some nuclear family cultures, people outside the fam-ily frequently care for children and sick or elderly relatives. Never assume anything about a family’s organization. It is important to ask questions and observe the family.

Some families are patriarchal and the father or oldest male is the authority fi gure. In a matri-archal family, the mother or oldest female is the authority fi gure. This also affects health care. In a patriarchal family, the dominant male will make most health care decisions for all family members. For example, in some Asian and Middle Eastern families, men have the power and authority, and women are expected to be obedient. Husbands frequently accompany their wives to medical appointments and expect to make all the medical care decisions. In a matriarchal family, the domi-nant female may assume this responsibility. For example, if the mother or other female is the dom-inant fi gure in a family, she will make the health decisions for all members of the family. In many families, both the mother and father share the decisions. Regardless of who the decision maker is, respect for the individual and the family must be the primary concern for the health care worker. Health care providers must respect patients who state, “I have to check with my husband (wife) before I decide if I should have the surgery.”

Recognition and acceptance of family orga-nization is essential for health care providers. Patients who have extended families as basic units may have many visitors in a hospital or long-term care center. Everyone will be con-cerned with the care provided, and all family members may help make decisions regarding care. At times, family members may even insist on providing basic personal care to the patient, such as bathing or hair care. Health care provid-ers must adapt to these situations and allow the family to assist as much as possible.

To determine a patient’s family structure and learn about a patient’s preferences, the

health care provider should talk with the patient or ask questions. Examples of questions that can be asked include:

♦ Who are the members of your family?

♦ Do you have any children? Who will care for them while you are sick?

♦ Do you have extended family? For example, aunts, uncles, cousins, nephews, nieces?

♦ Who will be caring for you while you are sick?

♦ Who is the head of the household?

♦ Where do you and your family live?

♦ Was your entire family born in the United States?

♦ What do you and your family do together for recreation?

♦ Do you have family members who will be vis-iting you? (If patient is admitted to a health care facility)

LANGUAGEIn the United States, the dominant language is English, but many other languages are

also spoken. Statistics from the U.S. Census Bureau verifi ed that more than 20 percent of the population younger than age 65 speaks a lan-guage other than English at home. There are even variations within a language caused by different dialects. For example, the German taught in school may differ from the language spoken by Germans from different areas of Germany. Health care providers frequently encounter patients who do not use English as a dominant language. The health care provider must determine the patient’s ability to communicate by talking with the patient or a relative and asking questions such as:

♦ Do you speak English as your primary lan-guage?

♦ What language is spoken at home?

♦ Do you read English? Do you read another language?

♦ Do you have a family member or friend who can interpret information for you?

Whenever possible, try to fi nd an interpreter who speaks the language of the patient (fi gure 9-5). Frequently, another health care worker, a consultant, or a family member may be able to assist in the communication process. Most health care facilities have a roster of employees who speak other languages.

When providing care to people who have limited English-speaking abilities, speak

slowly, use simple words, use gestures or pictures to clarify the meaning of words, and use nonver-




bal communication in the form of a smile or gen-tle touch if it is culturally appropriate. Avoid the tendency to speak louder because this does not improve comprehension. Whenever possible, try to obtain feedback from the patient to determine whether the patient understands the information that has been provided.

Most patients appreciate it when a health care worker can speak even a few words in the patient’s language. Make every attempt to try to learn some words or phrases in the patient’s lan-guage. Even a few words allow you to show the patient that you are trying to communicate. If you work with many patients who speak a com-mon language, such as Spanish, try to master the basics of that language by taking an introductory course or by using an audiotape.

Other resources are also available to help a health care provider meet the needs of a non-English-speaking patient. Many health care facil-ities have health care information or questions printed in several languages. Cards can be pur-chased that explain basic health care procedures or treatments in many other languages.

Most states require that any medical permit requiring a written signature be printed in

the patient’s language to ensure that the patient understands what he or she is signing. Health care providers must be aware of legal require-ments for non-English-speaking patients and make sure that these requirements are met.

FIGURE 9-5 Whenever possible, try to fi nd an interpreter to assist in communicating with a non-English-speaking patient.

PERSONAL SPACE AND TOUCH

Personal space, often called territorial space, describes the distance people require to feel com-fortable while interacting with others. This varies greatly among different ethnic/cultural groups. Some cultures are called “close contact” and oth-ers are called “distant contact.” Individuals from close-contact cultures are comfortable standing very close to and even touching the person with whom they are interacting. For example, Arabs are a very close-contact group; they touch, feel, and smell people with whom they interact. French and Latin Americans tend to stand very close together while talking. Hispanic Americans are also comfortable with close contact and use hugs and handshakes to greet others. Even within a cultural group, there are variations. For example, women tend to stand closer together than men do, and children stand closer together than adults do. European and African Americans prefer some space (approximately 2–6 feet) during interac-tions, but do not hesitate to shake hands as a greeting. Asian Americans will stand closer, but usually do not touch during a conversation. Kiss-ing or hugging is reserved for intimate relation-ships and is never done in public view. In Cambodia, members of the opposite sex may never touch each other in public, not even broth-ers and sisters. In addition, only a parent can touch the head of a child. The Vietnamese allow only the elderly to touch the head of a child because the head is considered sacred. In some Middle Eastern countries, men may not touch female individuals who are not immediate family members, and only men may shake hands with other men. This may cause a female from one of these countries to refuse personal health care provided by a male health care provider. For Native Americans, personal space is important, but they will lightly touch another person’s hand during greetings. It is important to understand that these situations are examples. You must never assume anything about an individual’s per-sonal space and touch preferences. You need to question the individual. Sample questions can be found at the end of this section.

Health care providers have to use touch and invade personal space to give many types of

care. For example, taking blood pressure involves palpation of arteries, wrapping a cuff around a per-



CHAPTER 9264

son’s arm, and placing a stethoscope on the skin. If a health care provider uses a slow, relaxed approach, explains the procedure, and encourages the patient to relax, this may help alleviate fear and eliminate the discomfort and panic that can occur when per-sonal space is invaded. Always be alert to the patient’s verbal and nonverbal communication, as well as inconsistencies between them. For exam-ple, a patient may give verbal permission for a pro-cedure, but may seem anxious when personal space is invaded and demonstrate nonverbal behavior such as tensing muscles, turning or pull-ing away, or shaking when touched. An alert health care provider can try to move away from the patient periodically to give the patient “breathing room” and encourage the patient to relax.

When personal care must be provided to a patient, the health care provider should

determine the patient’s preferences by talking with the patient or asking questions. Examples of questions may include:

♦ Do you prefer to do as much of your own per-sonal care as possible, or would you like assis-tance?

♦ Would you like a family member to assist with your personal care?

♦ Are there any special routines you would like followed while receiving personal care?

♦ Do you prefer to bathe in the morning or eve-ning?

♦ Is there anything I can do to make you more comfortable?

EYE CONTACTEye contact is also affected by different cultural beliefs. Most European Americans regard eye contact during a conversation as indicative of interest and trustworthiness. They feel that indi-viduals who look away are either not trustworthy or not paying attention. Some Asian Americans consider direct eye contact to be rude. Native Americans may use peripheral (side) vision and avoid direct eye contact. They may regard direct stares as hostile and threatening. Hispanic and African Americans may use brief eye contact, but then look away to indicate respect and attentive-ness. Muslim women may avoid eye contact as a sign of modesty. In India, people of different socioeconomic classes may avoid eye contact with each other. The many different beliefs

regarding eye contact can lead to misunderstand-ings when people of different cultures interact.

Health care providers must be alert to the com-fort levels of patients while using direct eye contact and recognize the cultural diversity that exists. Lack of eye contact is often interpreted as “not listen-ing,” when in reality, it can indicate respect.

GESTURESGestures are used to communicate many things. A common gesture in the United States is nod-ding the head up and down for “yes,” and side to side for “no.” In India, the head motions for “yes” and “no” are the exact opposite. Pointing at some-one is also a common gesture in the United States and is frequently used to stress a specifi c idea. To Asian and Native Americans, this can represent a strong threat. Even the hand gesture for “OK” can be found insulting to some Asians.

Again, health care providers must be aware of how patients respond to hand gestures. If a patient seems uncomfortable with hand gestures, they should be avoided.

HEALTH CARE BELIEFSThe most common health care system in the United States is the biomedical health

care system or the “Western” system. This system of health care bases the cause of disease on such things as microorganisms, diseased cells, and the process of aging. When the cause of disease is determined, heath care is directed toward elimi-nating the microorganisms, conquering the dis-ease process, and/or preventing the effects of aging. Health care providers in the United States receive biomedical training and are licensed to practice as professionals. Some beliefs of this sys-tem of care include encouraging patients to learn as much as possible about their illnesses, inform-ing patients about terminal diseases, teaching self-care, using medications and technology to cure or decrease the effects of a disease or illness, and teaching preventive care.

Health care beliefs vary greatly. These beliefs can affect an individual’s response to health care. Most cultures have common conceptions regard-ing the cause of illness, ways to maintain health, appropriate response to pain, and effective meth-ods of treatment. Some of the common beliefs are shown in table 9-1. It is important to remem-




TABLE 9-1 Health Care Beliefs

CULTURE HEALTH CONCEPTS CAUSE OF ILLNESSTRADITIONAL HEALERS

METHODS OF TREATMENT

RESPONSE TO PAIN

South African

Maintain harmony of body, mind, and spirit

Harmony with nature

Illness can be prevented by diet, rest, and cleanli-ness

Supernatural causeSpirits and demonsPunishment from

GodConfl ict or

disharmony in life

Root doctorFolk practi-

tioners (community “mother” healer, spiritualist)

Restore harmonyPrayer or meditationHerbs, roots, poultices,

and oilsReligious ritualsCharms, talismans, and

amulets

Tolerating pain is a sign of strength

Some may express pain

Asian Health is a state of physical and spiritual harmony with nature

Balance of two energy forces: yin (cold) and yang (hot)

Imbalance between yin and yang

Supernatural forces such as God, evil spirits, or ancestral spirits

Unhealthy environ-ment

HerbalistPhysicianShaman

healer (physician–priest)

Cold remedies if yang is overpowering and hot remedies if yin is overpowering

Herbal remediesAcupuncture and

acupressureEnergy to restore

balance between yin and yang

Pain must be accepted and endured silently

Displaying pain in public brings disgrace

May refuse pain medication

European Health can be maintained by diet, rest, and exercise

Immunizations and preventive practices help maintain health

Good health is a personal responsi-bility

Outside sources such as germs, pollutants, or contaminants

Punishment for sins

Lack of cleanlinessSelf-abuse (drugs,

alcohol, tobacco)

PhysicianNurse

Medications and surgeryDiet and exerciseHome remedies and self-

care for minor illnessesPrayer and religious

rituals

Some express pain loudly and emotion-ally

Others value self-control in response to pain

Pain can be helped by medications

Hispanic Health is a reward from God

Health is good luckBalance between

“hot” and “cold” forces

Punishment from God for sins

Susto (fright), mal ojo (evil eye), or envidia (envy)

Imbalance between hot and cold

Native healers (Curandero, Espiritual-ista, Yerbero or herbalist, Brujo)

Hot and cold remedies to restore balance

Prayers, medals, candles, and religious rituals

Herbal remedies, especially teas

MassageAnointing with oilWearing an Azabache

(black stone) to ward off the evil eye

Many will express pain verbally and accept treatment

Others feel pain is a part of life and must be endured

(continues)



CHAPTER 9266

ber that not all individuals in a specifi c ethnic/cultural group will believe and follow all of the customs. The customs, however, might still infl u-ence an individual’s response to a different type of care.

Health care providers must understand that every culture has a system for health care based on values and beliefs that have existed for gener-ations. Individuals may use herbal remedies, reli-gious rites, and other forms of ethnic/cultural health care even while receiving biomedical health care. A major change in the practice of health care in the United States is the increase in the use of alternative health care methods. Many individuals are using alternative health care in addition to, or as a replacement for, biomedical care. Alternative health care providers include chiropractors, homeopaths, naturopaths, and hypnotists. Some types of treatments discussed in more detail in table 1-8 of Chapter 1:2, include:

♦ Nutritional methods: organic foods, herbs, vitamins, and antioxidants

♦ Mind and body control methods: relaxation, meditation, biofeedback, hypnotherapy, and imagery

♦ Energetic touch therapy: massage, acupunc-ture, acupressure, and therapeutic touch

♦ Body-movement methods: chiropractic, yoga, and tai chi

♦ Spiritual methods: faith healing, prayer, and spiritual counseling

It is important to remember that every indi-vidual has the right to choose the type of

health care system and method of treatment he or she feels is best. Health care providers must respect this right.

To determine a patient’s health care prefer-ences the health care provider should talk

with the patient and ask questions. Examples of questions may include:

♦ What do you do to stay healthy?

♦ Except for this current illness, do you feel that you are reasonably healthy?

♦ What do you feel is a healthy diet? Do you try to follow this diet?

♦ What do you do for exercise?

♦ Is there anything else that you do to stay healthy?

CULTURE HEALTH CONCEPTS CAUSE OF ILLNESSTRADITIONAL HEALERS

METHODS OF TREATMENT

RESPONSE TO PAIN

Middle Eastern

Health is caused by spiritual causes

Cleanliness essential for health

Male individuals dominate and make decisions on health care

Spiritual causesPunishment for

sinsEvil spirits or evil

“eye”

Traditional healers

Physician

MeditationCharms and amuletsMedications and surgeryMale health profession-

als prohibited from touching or examining female patients

Tolerating pain is a sign of strength

Self-infl icted pain is used as a sign of grief

Native Ameri-can

Health is harmony between man and nature

Balance among body, mind, and spirit

Spiritual powers control body’s harmony

Supernatural forces and evil spirits

Violation of a tabooImbalance between

man and nature

ShamanMedicine Man

Rituals, charms, and masks

Prayer and meditation to restore harmony with nature

Plants and herbsMedicine bag or bundle

fi lled with herbs and blessed by medicine man

Pain is a normal part of life and tolerance of pain signifi es strength and power

TABLE 9-1 Health Care Beliefs (continued)




♦ Why do you think people become ill?

♦ What health care treatment method do you use when you are ill?

♦ Why do you think you have become ill?

♦ Were you born in the United States? Were your parents born in the United States?

♦ Do you or your parents still follow the tradi-tions of your native land (or culture)? (If a patient and/or parents were not born in the United States)

SPIRITUALITY AND RELIGION

Spirituality and religion are an inherent part of every ethnic or cultural group. Spirituality is defi ned as the beliefs individuals have about themselves, their connections with others, and their relationship with a higher power. It is also described as an individual’s need to fi nd meaning and purpose in life (fi gure 9-6). When a person’s

spiritual beliefs are fi rmly established, the indi-vidual has a basis for understanding life, fi nding sources of support when they are needed, and drawing on inner and/or external resources and strength to deal with situations that arise. Spiritu-ality is often expressed through religious prac-tices, but spirituality and religion are not the same. Spirituality is an individualized and per-sonal set of beliefs and practices that evolves and changes throughout an individual’s life.

Religion is an organized system of belief in a superhuman power or higher power. Religious beliefs and practices are associated with a par-ticular form or place of worship. Beliefs about birth, life, illness, and death usually have a reli-gious origin. Some of the more common religious beliefs are shown in table 9-2. Religious beliefs that affect dietary practices are discussed in Chapter 11 in table 11-6.

Even though a religion may establish certain beliefs and rituals, it is important to remember that not everyone follows all of the beliefs or rituals of their own religion. In addition, some individuals are non-believers. For example, an atheist is a person who does not believe in any deity. An agnostic is an individual who believes that the existence of God cannot be proved or disproved. Health care providers must determine what an individual personally believes to be important and respect that individual’s beliefs.

To determine an individual’s spiritual and religious needs, the health care provider

should talk with the patient and ask questions. Examples of questions that may be asked include:

♦ Do you have a religious affi liation?

♦ Are there any spiritual practices that help you feel better (prayer, meditation, reading scrip-tures)?

♦ Do you normally pray at certain times of the day?

♦ Would you like a visit from a representative of your religion?

♦ Do you consult a religious healer?

♦ Do you observe any special religious days?

♦ Do you wear clothing or jewelry with a reli-gious signifi cance?

♦ Do you have any religious objects that require special care?

♦ Do your beliefs restrict any specifi c food or drink?

FIGURE 9-6 Spirituality is an individual’s need to fi nd meaning and purpose in life.



CHAPTER 9268

TABLE 9-2 Major Religious Beliefs

RELIGIONBELIEFS ABOUT BIRTH

BELIEFS ABOUT DEATH HEALTH CARE BELIEFS

SPECIAL SYMBOLS, BOOKS, RELIGIOUS PRACTICES

Baptist(Christian)*

No infant baptismBaptism after

person reaches age of under-standing

Clergy provides prayer and counseling to patient and family

Autopsy, organ donation, and cremation are an individual’s choice

No last rites

Oppose abortionSome believe in the

healing power of “laying on of hands”

May respond passively to medical treatment, believing that illness is “God’s will”

Physician is instrument for God’s intervention

Bible is holy bookRite of Communion

importantBaptism by full immersion

in water after a person reaches an age of under-standing and accepts Jesus Christ

Some use cross as symbol

Buddhism No infant baptism but have infant presentation to dedicate child to Buddha

Believe in reincarna-tion

Desire calm environ-ment and limited touching during the process of death

Buddhist priest must be present at death

Last rites chanted at bedside immediately after death

Autopsy and organ donation are con -troversial but usually regarded as an individual’s choice

Cremation is common

Suffering is an inevitable part of life

Illness is the result of negative Karma (a person’s acts and their ethical consequences)

Cleanliness is important to maintain health

Belief in Buddha, the “enlightened one”

Tipitaka, three collections of writings, are Buddhist canon

Nirvana, the state of greater inner freedom, is the goal of existence

Emphasize practice and personal enlightenment rather than doctrine or study of scripture

May use pictures or statues of Buddha as religious symbols

Some wear mala beads around the left wrist that may be removed only if absolutely necessary

Christian Scientist(Christian)*

No infant baptism No last ritesAutopsy only when

required by lawOrgan donation

discouraged but can be an individual’s decision

Illness can be eliminated through prayer and spiritual understanding

May not use medicine or surgical procedures

May refuse blood transfusions

Will accept legally mandated immuniza-tions


importantScience and Health by Mary

Baker Eddy is basic textbook of Christian Science

Prayer and faith will maintain health and prevent disease

Episcopal(Christian)*

Infant baptism (may be per-formed by anyone in an emergency)

Some observe last rites by priest

Autopsy and organ donation encouraged

Cremation is an individual’s choice

May use Holy Unction or anointing of the sick with oil as a healing sacrament


importantBook of Common PrayerUse cross as symbol

*Any religion that is designated as “Christian” has the following beliefs: (continues) God is one in three parts: Father, Son, and Holy Spirit Jesus Christ is the Son of God By accepting Jesus Christ, a person may be saved and inherit eternal life




TABLE 9-2 Major Religious Beliefs (continued)




Hinduism No ritual at birthNaming ceremony

is performed 10–11 days after birth to obtain blessings from gods and goddesses

Believe in reincarna-tion as humans, animals, or even plants

Ultimate goal is freedom from the cycle of rebirth and death

Priest ties thread around the neck or wrist of the deceased and may pour water in the mouth

Only family and friends may touch and wash the body

Autopsy and organ donation discour-aged but regarded as individual’s decision

Cremation preferred

Some believe illness is punishment for sins

Some believe in faith healing

Will accept most medical interventions

Abortion and birth control are discour-aged

Vedas, four books, are the sacred scripture

Brahma is principal source of universe and center of all things

All forms of nature and life are sacred

Person’s Karma is deter-mined by accumulated merits and demerits that result from all the actions the soul has committed in its past life or lives

Cows are sacred and feeding a cow is an act of worship

May use symbols such as statues of various gods, fl at stones, incense, or sandalwood

Islam (Muslim)

Believe that fi rst words an infant should hear at birth are “There is no God but Allah, and Mohammed is His prophet.”

Circumcision performed when 7 days old

Family must be with dying person

Dying person must confess sins and ask forgiveness

Only family touches or washes body after death

Body is turned toward Mecca after death

Autopsy only when required by law

Organ donation is permitted if donor consents in writing

Cremation not permitted

Illness is an atonement for sins

May face city of Mecca (southeast direction if in United States) fi ve times a day to pray to Allah

Ritual washing before and after prayer

Must take medications with right hand since left hand considered dirty

Allah is supreme deityMohammed, founder of

Islam, is chief prophetHoly Day of Worship is

sunset Thursday to sunset Friday

Koran is holy book of Islam (do not touch or place anything on top)

Prayer rug is sacredFast during daylight hours in

month of Ramadan and during other religious holidays

May wear item with words from Koran on arm, neck, or waist; do not remove or allow item to get wet

An Imam is a Muslim preacher and teacher

(continues)



CHAPTER 9270





Jehovah’s Witness (Christian)*

No infant baptismBaptism by

immersion done when child accepts beliefs

No last ritesAutopsy only when

required by law and body parts may not be removed

Organ donation discouraged but decision is an individual’s choice

All organs and tissues must be drained of blood before transplantation

Cremation permitted

Prohibited from receiv-ing blood or blood products

Elders of church will pray and read scrip-tures to promote healing

Medications accepted if not derived from blood products

Name for God is JehovahBible is holy book: New

World BibleRite of Communion

importantChurch elders provide

guidanceEach witness is a minister

who must spread the group’s teachings

Acknowledge allegiance only to kingdom of Jesus Christ and refuse allegiance to any government

Judaism (Orthodox)

No infant baptismMale circumcision

performed on 8th day after birth by Mohel (circumcisor), child’s father, or Jewish physician

Person should never die alone

Body is ritually cleaned after death

May bury dead before sundown on day of death and usually within 24 hours

Autopsy only when required by law

Organ donation only after consultation with rabbi

Cremation forbidden

May refuse surgical procedure or diagnos-tic tests on Sabbath or holy days

Family may want surgically removed body parts for burial

Ritual handwashing upon awakening and prior to eating

Lord God Jehovah is oneSabbath is sunset Friday to

sunset SaturdaySabbath is devoted to

prayer, study, and restTorah is basis of religion

(fi ve books of Moses)Rabbi is spiritual leaderCantor often leads prayer

services, performs marriages, and conducts funerals

Star of David is symbol of Judaism

Fast (no food or drink) during some holy days

Men may wear kippah or yarmulke (small cap) and a tallith (prayer shawl)

Lutheran (Christian)*

Infant baptism by sprinkling (may be performed by any baptized Christian in an emergency)

No last ritesAutopsy and organ

donation allowedCremation permitted

Communion often administered by clergy to sick or prior to surgery


importantUse cross as symbol

Methodist (United) (Christian)*

Infant baptism No last ritesOrgan donations

encouragedCremation permitted

May request communion before surgery or while ill


importantReligion is a matter of

personal belief and provides a guide for living

Use cross as symbol(continues)








Mormon (Latter Day Saints)

Infant blessed by clergy in church as soon as possible after birth

Baptism at 8 years of age

May want church elders present at death

No last ritesAutopsy and organ

donation is individu-al’s decision

Cremation discour-aged

May believe in divine healing with “laying on of hands” by church elders

Anointing with oil can promote healing

Mormon refers to the four holy books: The Bible, The Book of Mormon, The Doctrine and Covenants, and Pearl of Great Price

Special undergarment may be worn to symbolize dedication to God and should not be removed unless necessary

Fast on fi rst Sunday of each month

Avoid medications contain-ing alcohol or caffeine

Presbyterian (Christian)*

Infant baptism No last ritesAutopsy and organ

donation permittedCremation permitted

Prayer and counseling an important part of healing

May request communion while ill or before surgery


importantSalvation is a gift from GodUse cross as symbol

Roman Catholic (Christian)*

Infant baptism mandatory

Baptism neces-sary for salvation (any baptized Christian may perform an emergency baptism)

Sacrament of the Sick (last rites) performed by priest

Autopsy and organ donation permitted

Cremation permitted

Sacrament of the Sick and anointing with oil

Life is sacred: abortion and contraceptive use prohibited

Believe embryos are human beings and should not be destroyed or used for research

Bible is holy bookRite of Holy Eucharist (Com-

munion) importantMay use prayer books,

crucifi x, rosary beads, religious medals, pictures and statues of saints

Confession used as a rite for forgiveness of sins

Use cross as symbol

Russian Orthodox (Christian)*

Infant baptism by priest

Last rites by ordained priest mandatory

Arms of deceased are crossed

Autopsy only if required by law

Organ donations not encouraged

Cremation prohibited

Holy Unction and anointing body with oil used for healing

Will accept most medical treatments but believe in divine healing


importantMay wear a cross necklace

that should not be removed unless absolutely necessary

Use cross as symbol

Seventh Day Adventist (Christian)*

No infant baptism (baptize individu-als when they reach the age of accountability)

No last ritesAutopsy only when

required by lawOrgan donation is an

individual’s decision

May avoid over-the-counter medications and caffeine

May anoint body with oilUse prayer for healingSome believe only in

divine healingWill accept required

immunizations

Literal acceptance of Holy Bible

Rite of Communion important

Sabbath worship is sunset on Friday to sunset on Saturday



CHAPTER 9272

♦ Do you fast or abstain from eating certain foods?

♦ Should food be prepared in a certain way?

♦ Do you prefer certain types of foods (vegetar-ian diet, diet free from pork)?

As long as it will not cause harm, every effort must be made to allow an individual to express his or her beliefs, practice any rituals, and/or fol-low a special diet. To show respect for an individ-ual’s beliefs and practices, the health care worker should:

♦ Be a willing listener.

♦ Provide support for spiritual and religious practices.

♦ Respect religious symbols and books (fi gure 9-7).

♦ Allow privacy for the patient during clergy vis-its or while the patient is observing religious customs such as communion, prayer, and meditation.

♦ Refrain from imposing your own beliefs on the patient.

9:4 INFORMATIONRespecting Cultural DiversityThe key to respecting cultural diversity is to regard each person as a unique individual. Every indi-vidual adopts beliefs and forms a pattern of

behavior based on culture, ethnicity, race, life experiences, spirituality, and religion. Even though this pattern of behavior and beliefs may change based on new exposures and experiences, they are still an inherent part of the individual.

Health care workers must be aware of the needs of each individual to provide total care. They must learn to appreciate and respect the personal characteristics of others. Some ways to achieve this goal include:

♦ Listen to patients as they express their beliefs.

♦ Appreciate differences in people.

♦ Learn more about the cultural and ethnic groups that you see frequently.

♦ Recognize and avoid bias, prejudice, and ste-reotyping.

♦ Ask questions to determine a person’s beliefs.

♦ Evaluate all information before forming an opinion.

♦ Allow patients to practice and express their beliefs as much as possible.

♦ Remember that you are not expected to adopt another’s beliefs, just accept and respect them.

♦ Recognize and promote the patient’s interac-tions with family.

♦ Be sensitive to how patients respond to eye contact, touch, and invasion of personal space.

♦ Respect spirituality, religious beliefs, symbols, and rituals.

STUDENT: Go to the workbook and complete the assignment sheet for Chapter 9, Cultural Diversity.

CHAPTER 9 SUMMARY

Because health care providers work with and care for many different people, they must be aware of the factors that cause each individual to be unique. These factors include culture, eth-nicity, and race. Culture is defi ned as the values, beliefs, attitudes, languages, symbols, rituals, be-haviors, and customs unique to a group of peo-ple and passed from one generation to the next.

FIGURE 9-7 Always respect the patient’s religious symbols and books.




Ethnicity is a classifi cation of people based on national origin and/or culture. Race is a classifi -cation of people based on physical or biological characteristics. The differences among people resulting from cultural, ethnic, and racial factors are called cultural diversity. Health care provid-ers must show sensitivity, or recognize and ap-preciate the personal characteristics of others, because America is a multicultural society.

Bias, prejudice, and stereotyping can inter-fere with acceptance of cultural diversity. A bias is a preference that inhibits impartial judgment. A prejudice is a strong feeling or belief about a person or subject that is formed without review-ing facts or information. Stereotyping occurs when an assumption is made that everyone in a particular group is the same. Bias, prejudice, and stereotyping are barriers to effective relation-ships with others. Health care providers must be alert to these barriers and make every effort to avoid them.

An understanding of cultural diversity al-lows health care providers to give holistic care; that is, care that provides for the well-being of the whole person and meets not only physical, but also social, emotional, and mental needs.

Some areas of cultural diversity include family organization, language, personal space, touch-ing, eye contact, gestures, health care beliefs, spirituality, and religion.

The key to respecting cultural diversity is to regard each person as a unique individual. Health care providers must learn to appreciate and re-spect the personal characteristics of others.

INTERNET SEARCHESUse the suggested search engines in Chapter 12:4 of this textbook to search the Internet for addi-tional information on the following topics:

1. Cultural diversity: search words such as culture, ethnicity, and race to obtain additional information on characteristics and examples for each

2. Ethnic groups: search countries of origin for information on different ethic groups or on your own ethnic group; for example, if you are German–Irish, search for information on both Germany and Ireland

TODAY’S RESEARCH: TOMORROW’S HEALTH CARE

A computer microchip that allows a physician to know what medication a person needs?A major problem in health care today is determining what drug and what dosage should

be used for a patient. Individuals react to medications in different ways. Some individuals need large amounts of pain medication; others need smaller quantities. A blood pressure medication works well for one individual, but is not effective for another patient. An antibi-otic cures an infection in one person but causes an allergic reaction that kills another per-son. Pharmacogenetics, or prescribing medicine based on a person’s unique genetic makeup, is the start of a revolution in personalizing treatment for a particular individual.

Researchers are using genetic information about individuals to try to determine their reactions to different medications. Scientists have proved that there is a gene in a person’s body that controls how a drug is absorbed, used, and eliminated. This gene may be different from person to person. By learning an individual’s genetic makeup, a physician could pre-scribe the exact medication and dosage that would be most benefi cial to a patient.

Imagine a future where people will have a computer chip that contains all of their genetic information. Before any medication is given to a patient, the genetic information will be scanned to make sure it is compatible with the chemical properties of the medication. A computer will analyze the information and determine the exact dosage needed by the patient. Even though this process raises concerns about patient confi dentiality, privacy, and legal regulations, it has the potential to save lives. If a medicine given to a patient is based on that person’s specifi c needs, diseases will be cured because they will be treated correctly.



CHAPTER 9274

3. Cultural assimilation and acculturation: search for additional information on these two topics

4. Bias, prejudice, and stereotyping: use these key words to search for more detailed information

5. Family structure: search words such as extended or nuclear family, patriarchal, and/or matriarchal

6. Health care beliefs: search by country of origin for health care beliefs, or search words such as yin and yang or shaman

7. Alternative health care: search for additional information on chiropractor, homeopath, naturopath, hypnotist, hypnotherapy, medita-tion, biofeedback, acupuncture, acupressure, therapeutic touch, yoga, tai chi, and/or faith healing

8. Spirituality and religion: search for additional information on spirituality; use the name of a religion to obtain more information about the beliefs and practices of the religion

REVIEW QUESTIONS

1. Differentiate between culture, ethnicity, and race.

2. Name fi ve (5) common ethnic groups and at least two (2) countries of origin for each group.

3. Create examples of how a bias, prejudice, and stereotype may interfere with providing quality health care.

4. Describe your family structure. Is it a nuclear or extended family? Is it patriarchal or matriar-chal or neither? Why?

5. Do you feel acculturation occurs in the United States? Why or why not?

6. Describe at least three (3) different health care practices that you have seen or heard about. Do you feel they are benefi cial or harmful? Why?

7. Differentiate between spirituality and religion.

8. List six (6) specifi c ways to respect cultural diversity.

NOTE: The cultural assessment questions presented in this unit were adapted from Joan Luckmann’s Transcultural Communication in Health Care, which adapted them from Fong’s CONFHER model and Rosenbaum.



diversified health occupations · 2016. 10. 12. · matthew kane managing editor: marah bellegarde...

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